Going beyond the audiogram

 My fellow audiologists:

At what point do we move beyond the audiogram or pushes its limits? Should we at least update it? I mean after all, in terms of plotting data on a graph, we are literally doing it upside down, from top to bottom. I must confess I find it troublesome that we remain so fixated on audiograms.

Don't get me wrong, there is so much information to glean from an audiogram, and I love how there are so many self-check elements built in to validate each part of the battery of tests. Yet, have we maximized its utility and can it be improved upon?

Truth be told, an audiogram can only go so far, and my fear is we remained too confined by it. We don't communicate in beeps, we are not R2D2, yet we test that way. We rarely converse in truly quiet settings, speaking at a steady rate. Yet we bank on word recognition to tell us how the person should do in real life. There are those who do hear above 0dB HL and beyond 8kHz, and while their thresholds may appear "normal "could mean a significant shift had we a baseline that tested the "extremes".

The audiogram is the entry point, and too often we allow it to become the whole narrative. We ought to be asking more. How is the brain being engaged given this information, and have we tested the full-spectrum?

How do we present this data to others? The fact that there are a significant number of us who find having an engineer or a musician as a patient troublesome speaks volumes about us as a profession, not them. They are the ones who understand sounds beyond what a graph dictates, and we should too. Convince them that we understand. The unit of measurement for sound, dB, is a relative unit - how do we relate it? How do we go from here's how you hear to here's how you listen?

I think it is time we go beyond the audiogram, the X and Os, the brackets. We need to explore more. We need to make sure we perform more objective measurements like immittance audiometry, and electrophysiology tests. That's where we make the difference. Let's not get hung up on audiograms and how we ought to fit hearing aids based on them; we as a profession are more than that.